title: Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine.
abstract: BACKGROUND
  In many Emergency Department (ED) triage scoring systems, vital signs are not included as an assessment parameter.
  
  
  OBJECTIVE
  To evaluate the validity of a new protocol for Emergency Medicine in a large cohort of patients referred to in-hospital care.
  
  
  METHODS
  From January 1 to June 30, 2006, 22,934 patients were admitted to the ED at Sahlgrenska University Hospital. Of those, 8695 were referred to in-hospital care and included in the study. A new five-level triage tool, combining vital signs, symptoms, and signs in the triage decision, was used. A small control of the inter-rater disagreement was also performed in 132 parallel, single-blinded observations.
  
  
  RESULTS
  Fifty percent of the patients were admitted by ambulance and the other 50% by walk-in. Hospital stay was significantly (p < 0.001) longer in those admitted by ambulance (9.3 ± 14 days) as compared with walk-in patients (6.2 ± 10 days). In-hospital mortality incidence was higher (8.1%) in patients admitted by ambulance, as compared with walk-in patients (2.4%). Hospital stay and in-hospital mortality increased with higher level of priority. In the highest priority groups, 32-53% of the patients were downgraded to a lower priority level after primary treatment.
  
  
  CONCLUSIONS
  In the present study, the METTS protocol was shown to be a reliable triage method and a sensitive tool for secondary re-evaluation of the patient in the ED.
authors.affiliation: Department of Accident and Emergency Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Bengt R
authors.initials: BR
authors.lastname: Widgren
authors.forename: Majid
authors.initials: M
authors.lastname: Jourak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000552:Ambulances; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods*; D055986:Vital Signs